Family Medicine Update

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Home-based medication review in a high risk elderly population in primary care–the POLYMED randomised controlled trial.

Age Ageing. 2007 Mar 26;

Authors: Lenaghan E, Holland R, Brooks A

OBJECTIVE: to assess whether home-based medication review by a pharmacist for at-risk older patients in a primary care setting can reduce hospital admissions. DESIGN: randomised controlled trial comparing home-based medication review with standard care. SETTING: home-based medication review of 136 patients registered with one general practice. Method: study participants were over 80 years of age, living at home, taking four or more medicines, and had at least oneadditionalmedicines-related risk factor. The intervention comprised two home visits by a community pharmacist who educated the patient/carer about their medicines, noted any pharmaceutical care issues, assessed need for an adherence aid, and subsequently met with the lead GP to agree on actions. Main outcome measure: total non-elective hospital admissions within 6 months. Secondary outcomes included number of deaths, care home admissions and quality of life (EQ-5d). Impact on number of medicines prescribed was also assessed. RESULTS: at 6 months, no difference in hospital admissions (21 intervention versus 20 control P = 0.80), and no difference in care home admissions or deaths were detected between groups. There was a small (non-significant) decrease in quality of life in the intervention group. There was a statistically significant reduction in the mean number of medicines prescribed ( -0.87 items in favour of the intervention group, 95% confidence interval -1.66 to -0.08, P = 0.03). CONCLUSIONS: no positive impact on clinical outcomes or quality of life was demonstrated, however, this intervention did appear to reduce prescribing. This is in line with other evidence and suggests that this form of intervention may not have a clear health gain, but may lead to modest savings in terms of reduced prescribing. Future research should focus on whether such a prescribing effect would make this type of intervention cost effective.

PMID: 17387123 [PubMed - as supplied by publisher]

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The role of patient personality in the identification of depression in older primary care patients.

Int J Geriatr Psychiatry. 2007 Apr 3;

Authors: McCray LW, Bogner HR, Sammel MD, Gallo JJ

BACKGROUND: Our aim was to evaluate whether personality factors significantly contribute to the identification of depression in older primary care patients, even after controlling for depressive symptoms. METHODS: We examined the association between personality factors and the identification of depression among 318 older adults who participated in the Spectrum study. RESULTS: High neuroticism (unadjusted Odds Ratio (OR) 2.36, 95% Confidence Interval (CI) [1.42, 3.93]) and low extraversion (adjusted OR 2.24, CI [1.26, 4.00]) were associated with physician identification of depression. Persons with high conscientiousness were less likely to be identified as depressed by the doctor (adjusted OR 0.45, CI [0.22, 0.91]). CONCLUSION: Personality factors influence the identification of depression among older persons in primary care over and above the relationship of depressive symptoms with physician identification. Knowledge of personality may influence the diagnosis and treatment of depression in primary care. Copyright (c) 2007 John Wiley & Sons, Ltd.

PMID: 17407104 [PubMed - as supplied by publisher]

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Learning procedural skills in family medicine residency: comparison of rural and urban programs.

Can Fam Physician. 2006 May;52:622-3

Authors: Goertzen J

OBJECTIVE: To determine whether family medicine residents graduating from rural programs assess themselves as more experienced and competent in a range of procedural skills than graduates of urban programs do. DESIGN: Self-administered written survey. SETTING: Ontario. PARTICIPANTS: Residents from 5 Ontario family medicine programs in 2000 and 2001; a total of 535 surveys were available for analysis (response rate of 78%). MAIN OUTCOME MEASURES: Mean self-assessed experience and competence scores for 53 procedures at residency entry, end of year 1, and graduation. RESULTS: Upon entry, there was no difference in mean procedural experience (2.89 vs 2.85, P = .54) or mean competence (2.34 vs 2.36, P = .88) scores between rural residents and their urban counterparts. There was a significant increase in procedural experience (P < .001) and competence (P < .001) scores during residency training. At graduation, mean experience (3.98 vs 3.70, P < .001) and competence (3.67 vs 3.39, P = .004) scores were significantly higher for rural residents than for their urban colleagues. A statistically larger proportion of residents graduating from rural programs assessed themselves as competent in 16 procedures. These included skills necessary for treating patients in emergency settings (establish intravenous lines for adults and infants, obtain arterial blood gas measurements, intubate adults and neonates, perform cautery for epistaxis, remove corneal foreign body, aspirate or inject knee and shoulder joints, and apply forearm or walking casts), for diagnostic procedures (endometrial biopsy and bone marrow aspiration), and for management of labour and delivery (vaginal delivery; vacuum extraction; and repair of first-, second-, and third-degree tears). CONCLUSION: Graduates of rural programs who have had a substantial component of training in communities of fewer than 10,000 people report greater self-assessed experience and competence in procedural skills than graduates of urban programs do. The difference likely reflects the unique aspects of rural training sites, including preceptors’ competence in performing procedures.

PMID: 17327892 [PubMed - indexed for MEDLINE]

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